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NPI Code Detail

MEDICARE: MRS. ANGELICA DANIEL RICHARD LCSW

MEDICARE: MRS. ANGELICA DANIEL RICHARD LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor62179TX
21041C0700XClinical Social Worker62179TX

General Provider Information

NPI Number : 1356075832
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANGELICA DANIEL RICHARD LCSW
Provider Business Mailing Address
First Line : 5408 GRAYSON RIDGE DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76179-7111
Country : US
Telephone Number : 469-964-5984
Fax Number :
Provider Business Practice Location Address
First Line : 4500 MERCANTILE PLAZA DR STE 307
Second Line :
City : FORT WORTH
State : TX
Zip : 76137-4230
Country : US
Telephone Number : 817-232-9400
Fax Number : 817-232-9403
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2022
Last Update Date : 04/02/2024

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